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Jane Ahlin, Published March 31 2012

Ahlin: Irrational wishful thinking about health care dilemma

Dick Cheney received a heart transplant, and the U.S. Supreme Court heard three days of oral argument about the constitutionality of the Patient Protection and Affordable Care Act (better known as Obamacare). The combination of the two events struck some pundits as ironic. However, a more important point is how clearly the combination underscores America’s irrational attitude toward health care.

When the country learned that the former vice president, who is 71, had received a new heart, the immediate question was about his age. Was he “too old”? Then, another question: Did his prominence play a role in getting a heart transplant?

The answer to the age question seems to be that other Americans – not many, but a few – between the ages of 70 and 72 have received new hearts.

To qualify in that age group, patients can’t have other medical problems unrelated to their compromised hearts. (Note: In the kidney world, 80- year-olds have received transplants and 90-year-olds are dialyzed.)

As to the second question about his national prominence figuring into transplant access, those in the know say special treatment wasn’t a factor – at least, not because he’d occupied high office. He waited 20 months for the transplant, which is longer than average. The kind of special treatment Cheney received is related to having Medicare and terrific supplemental insurance. No problem, his bills are paid.

Insurance – more specifically, employer-based insurance – has been the name of the health care game since World War II; no surprise it also is central to Obamacare, which is premised on the idea that all Americans belong in the risk pool: thus, the health insurance individual mandate. (Whether Congress can mandate buying insurance is to be ruled on by SCOTUS.) Put another way, to have a Dick Cheney costing the system a million dollars, there has to be a huge roster of healthy people paying in more than they are using.

Behind the Obamacare mandate is the reality that health care is not like other insurance, such as fire insurance or car insurance. If your house doesn’t burn down or you don’t have a car accident, you pay into the system but you are happy not to collect.

With health insurance, however, there’s a rub: Everybody needs health care. The risk pool is made up of users and depends upon some people using much less health care than they are paying for. But Americans are consumers who see health care as a product, and if we’re paying insurance premiums, we’re going to use it.

As a retired corporate executive said to me, “Insurance may not be the best way to deliver health care.” That’s probably right. And yet, we work from what we know, and what we know is insurance-based care.

Nationalized health care has been high on the national radar since Richard Nixon’s presidency. In truth, it was discussed as early as the Teddy Roosevelt days, but it wasn’t until 1965 that Medicare and Medicaid – the first concrete moves toward national health care – became law. (Interestingly, it was a Republican from Wisconsin, John Byrnes, who was crucial to the 1965 legislation.)

As costs have risen exponentially over the past few decades, the importance of doing something (anything!) has grown, in large part because more and more employers have scaled back benefit packages and upped employee co-pays or quit offering insurance altogether.

In 2009, The American Journal of Medicine reported that bankruptcies because of medical bills accounted for more than 60 percent of all bankruptcies (nearly two-thirds). And, of course, the number of uninsured Americans is more than 40 million and growing.

That’s where we are. Polls show that the majority of Americans object to mandated insurance but don’t want to be denied insurance for pre-existing conditions – irrational wishful thinking because the two cannot co-exist.

On the other hand, if Medicare gets Grandpa a heart transplant and takes care of Great-Grandma’s dialysis, can we be blamed for thinking we can have it all?


Ahlin writes a Sunday column for The Forum.